Cardiomegaly of unknown origin among Nigerian adults: role of hypertension in its aetiology.

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Abstract
Nigerians (50) with cardiomegaly of unknown origin were followed up over a period of 1-4 yr. This condition was defined as congestive cardiac failure and cardiac enlargement of unknown cause with a presenting diastolic blood pressure of not more than 100 mmHg. Of the patients, 24 presented with a normal blood pressure (diastolic blood pressure below 90 mmHg) and 26 with a diastolic blood pressure of 90-100 mmHg. Each patient was initially treated in hospital with digoxin and frusemide and followed up as an out-patient. Of the 24 normotensive patients, 18 remained normotensive throughout the entire observation period. Heart failure was controlled with digoxin and frusemide both as an in-patient and in the subsequent out-patient follow-up. The heart failure of the remaining 6 patients was controlled in hospital, but they developed high blood pressures and relapsed into heart failure during out-patient follow-up on digoxin and frusemide. They needed antihypertensive therapy in the form of thiazides or methyldopa and thiazides to prevent heart failure. Patients (20) with initially raised blood pressures responded to in-patient treatment with a fall in blood pressure and remission of their cardiac failure. During out-patient follow-up the blood pressure became raised again and cardiac failure reappeared. These patients needed antihypertensive therapy to produce a sustained fall in blood pressure and relief of heart failure. Six other patients who presented with raised blood pressures did not respond, even as in-patients, until antihypertensive therapy was instituted. Not all Nigerians with cardiomegaly of unknown origin are hypertensives. The mild hypertension seen in some of the patients contributes to their morbidity and is not a result of their heart failure. Hypertension is probably not the sole cause of their heart failure but acts in concert with other factors to produce severe myocardial damage.